Early Post-Hospitalization Therapy Cuts Opioid Overdose Risk

TOPLINE:

Initiating medication for opioid use disorder (OUD) within 7 days of a hospital visit reduces the risk for fatal or nonfatal opioid overdose at 6 months; however, this association is not seen at 12 months.

METHODOLOGY:

• Hospital visits, including emergency department (ED) visits and inpatient admissions, present opportunities to initiate medication for OUD, potentially reducing the risk for future overdoses.
• This retrospective cohort study included 22,235 patients (aged ≥18 years) with an OUD-related hospital visit and used data from the Oregon Comprehensive Opioid Risk Registry database with diagnosis codes recorded at an index ED visit or hospitalization from January 2017 to December 2019.
• Among them, 1184 patients (5.3%) received medication for OUD within 7 days of an ED visit or hospitalization, with 683 receiving buprenorphine, 463 receiving methadone, and 46 receiving long-acting injectable naltrexone.
• The primary outcome was the first occurrence of a nonfatal or fatal opioid-related event 6 and 12 months after an OUD-related hospital visit.

TAKEAWAY:

• Overall, 452 nonfatal and fatal overdose events were reported at 6 months, and 758 overdose events were reported at 12 months.
• At 6 months, patients who received medication for OUD within 7 days after discharge had a lower risk for fatal or nonfatal overdose than those who did not receive such medication (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.97).
• At 12 months, the odds of fatal or nonfatal overdose were not significantly different between patients who received and those who did not receive medication for OUD (AOR, 0.79; 95% CI, 0.58-1.08).
• Buprenorphine was associated with a lower risk for fatal or nonfatal overdose at 6 months (AOR, 0.50; 95% CI, 0.27-0.95), but no significant association was observed with methadone.

IN PRACTICE:

“The findings of this cohort study suggest that initiation of MOUD [medication for OUD] after hospital visits is associated with reduced odds of opioid-related overdose at 6 months. Hospitals and their associated EDs should consider implementing programs and protocols to offer initiation of MOUD to patients with OUD who present for care,” the authors wrote.

SOURCE:

The study, led by Scott G. Weiner, MD, MPH, Brigham and Women’ s Hospital, Boston, Massachusetts, was published online on July 22, 2024, in JAMA Network Open.

LIMITATIONS:

This retrospective observational study relied on administrative billing code data, which might not capture all relevant information. The requirement for continuous insurance enrollment likely excluded the most vulnerable patients. The study did not include race and ethnicity data due to substantial missingness in the data, limiting the generalizability of the findings. Readiness of patients for MOUD [medication for OUD] treatment and comorbid conditions could not be determined.

DISCLOSURES:

The research was supported by grants from the National Institute on Drug Abuse, National Institutes of Health, and the Agency for Healthcare Research and Quality. One author disclosed receiving personal fees from Vertex Pharmaceuticals, Inc. and Cessation Therapeutics, Inc.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.